Stigma

by Philip Hawley Jr.

  The woman’s gaze swung back and forth between her daughter and her trembling hands. Finally, she said, “Yes.”

  “I hope you also understand that we’re doing this out of concern for both of you. We need to be sure that you and your daughter are safe, which I know is also what you want.”

  She nodded without looking up. The shields were coming down.

  “We can help you deal with this,” he said.

  “There’s nothing to deal with.”

  “I think there is,” Luke broke in.

  Dennis shot a glance at Luke. The message was clear: Let me handle this.

  But Luke knew they were battling the same frustration. For reasons a man could not easily understand, this battered woman would probably retreat into the clutches of her captor. She seemed to shoulder the feelings of shame and worthlessness as though she’d come to accept them as part of her core identity.

  Everyone in the room shared at least one feeling — helplessness. Luke watched the woman knead the palms of her hands with nervous thumbs. He wondered how she endured the cruelty in silence. He wondered how she could surrender herself to the creature that had beaten her child.

  But this woman had come to the hospital. At least part of her was begging for help.

  A man’s angry shouts interrupted Luke’s thoughts — an enraged parent launching into a tirade down the hall.

  Moments later there was a loud smack—someone’s fist slamming against a wall or countertop.

  The woman flinched, her breathing quickened, and her face bloomed with fear.

  * * *

  Calderon stood at the curb outside the terminal and watched the ambulance blast its way through a phalanx of traffic. Brake lights veered to each side of the street in a modern day version of the Red Sea. A duet of sirens faded to a low-pitched yawn as the flashing lights shrank into the distance.

  “What do you mean, you lost him?” asked the voice in his earpiece. The encryption technology built into Calderon’s cell phone shaved some of the subtle inflections from his client’s digitally reconstructed words, giving them an unnatural quality.

  Calderon spoke into the tiny boom microphone hanging from his right ear. “A medical team took the kid away on a stretcher. There was no way to grab him. Cops and security were all around him.”

  He unbuttoned his black coat and pressed a hand against his left ear to muffle the street noise. The coat collar rose awkwardly on his steeply sloped shoulders, and his flexed arm swelled like a tire filling with air. Calderon had always been big, favoring the genes of the German banker in Guatemala City whose home his then-teenage mother had cleaned for the equivalent of fifteen U.S. cents a day.

  After a three-second delay during which Calderon’s phone ciphered the encrypted code, his client’s voice came back: “He was alive?”

  “Yeah, but it looked like he was struggling to breathe.” Calderon stepped away from a noisy Chinese couple who were barking at each other in what sounded like Cantonese. He was careful to stay beyond the reach of three security cameras tucked into the ceiling over the baggage carousels. “Airport security had cordoned off a path. I couldn’t see much.”

  During the commotion, he had joined a crowd of spectators who stood gawking as a medical team — dressed in blue coveralls with incongruously cheerful rainbow insignias — trotted alongside the stretcher carrying his mission objective. Calderon had caught only a fleeting glimpse of the boy grimacing through an oxygen mask as the stretcher raced through the baggage claim area.

  “You’re sure it was our boy?” asked the flat voice in his earpiece.

  Encryption technology didn’t explain everything that Calderon was hearing, and not hearing. The pitch of his client’s voice was oddly high, and his words were stripped of the intonations that gave human speech its texture. His client was using embedded software to camouflage his voice.

  “My man at the gate got a good look at him. It was our boy,” Calderon said. “His mother was right there, too, walking alongside the stretcher. She matched the picture you sent me. One of the medical people was firing questions at her.”

  He raked his upper lip with his teeth. His paste-on moustache was beginning to itch. The rest of his disguise was minimal: implants stuffed inside his cheeks to soften the lines of his face, red-tinted eyeglasses, and a wig. The wig was just long enough to cover the lower half of his left ear, which was missing.

  His mother had always wanted him to get that ear fixed. Now, he wished he had — for her.

  A small throng of camera-toting tourists spilled out the exit, luggage in tow, passing on either side of him. Calderon turned to avoid the lens of a trigger-happy woman for whom the taxi-stand sign held some profound photographic interest.

  Just as he turned, a swarthy young man brushed up against him. Rap music leaked from headphones that were hanging loosely around the man’s neck.

  The would-be chauffeur’s right hand instinctively twitched toward the shoulder holster that wasn’t there. The weapon was tucked away in the trunk of his rented town car.

  After another several-second delay, the voice in Calderon’s earpiece said, “Do you know where they’re taking him?”

  A chorus of horns sounded.

  “The logo on the side of the ambulance says University Children’s Hospital,” Calderon said — too loudly, he realized. He glanced to either side.

  The swarthy man was crossing the street, walking toward the parking structure. Something about his casual gait seemed exaggerated, like that of a stage actor who wasn’t yet comfortable in his role.

  A gust of wind whipped up a sooty air funnel. Calderon reached down and rebuttoned his blazer.

  Something didn’t feel quite right. His body had always perceived the smallest things, things that were imperceptible to others. The left side of his blazer was too light, a few ounces of drag missing when he drew the lapels together.

  His wallet was gone.

  His eyes shot across the street.

  The swarthy man was walking into the parking structure.

  3

  Megan Callahan challenged the thick metal doors with a heavy stare, willing them to remain shut until she was ready — which might be never, she realized. Her blank expression and clouded blue eyes were a message to the other members of the trauma team: I’m preparing. Leave me to my thoughts.

  University Children’s Hospital was the third largest pediatric hospital in the United States, and one of only a few medical centers in southern California equipped to deal with critically ill children. The first stop for every patient arriving by ambulance was the Trauma Unit.

  Each team member had an idiosyncratic habit that erupted like a nervous tic during the final moments before a patient arrived. Susan, the charge nurse, fiddled with instruments and medication vials until they were just so, lining them up on the stainless steel tray like little soldiers at parade rest. The other nurse, sporting an oversized nose ring that almost made his spiked orange hair a nonevent, stepped on every moment of silence with idle chitchat. The respiratory therapist checked and rechecked her equipment, her demeanor grim, as always. And Megan, third-year pediatric resident, stood motionless, staring at the well-worn swinging doors, her gloved hands joined at the chest.

  Gloves and goggles were the only common element of dress among the four persons standing in Trauma One. They were otherwise a motley crew. Megan was wearing a threadbare yellow smock over well-worn jeans and a green blouse, Susan favored loose-fitting floral scrubs, the other nurse a purple tie-dye creation, and the respiratory therapist wore dark blue scrubs.

  Megan’s mouth felt dry. At its best, trauma medicine was an edge-of-your-seat display of exquisitely choreographed action and reaction. At its worst, it was bedlam. She didn’t care much for either image. After all, she was training to be a general pediatrician, not one of those emergency medicine types who suffered from adrenaline-seeking behavior.

  A siren suddenly invaded her thoughts, and pulses of red light pierced through the
room’s casement windows. A knot formed in her stomach, and then just as quickly uncoiled as the ambulance raced past their hospital.

  She let out a heavy sigh, and hoped that no one noticed.

  “Megan, what do you know about this kid we’re getting?” asked Susan. The charge nurse’s tone, as usual, bordered on interrogative.

  “Not much. A four-year-old boy — his white blood count is off the charts, mostly lymphocytes. He showed up at our clinic in Guatemala and—”

  Nose Ring turned to Megan, his eyebrows lifted. “Aren’t you going there next month?”

  “I leave in a couple of days,” Megan said. “Can’t wait to get on the plane.”

  Like other senior residents nearing the end of their training, she had the option to spend four weeks at the northern Guatemalan clinic in lieu of a second month in the E.R. She had jumped at the opportunity, but for reasons that differed from her colleagues who simply wanted a break from the hospital routine. Her reasons had more to do with healing her ragged spirits. She needed to get out of the E.R. and its daily reminders of her shattered romance with Luke McKenna.

  She didn’t know much about the clinic, which was located in northern Guatemala and staffed by volunteers from University Children’s. Each year at least a dozen patients from the Guatemalan clinic arrived at University Children’s, usually for specialized surgical procedures. The patient arriving tonight was different; he was a diagnostic conundrum.

  “Lotta short people down there,” Nose Ring said to Megan. “Except for the blue eyes, you’ll fit right in.”

  “Yeah, well, I’ve always wanted to go someplace where short and muscular were considered chic,” Megan said. Despite her trim body — the only benefit of a work life that encroached on meals — she couldn’t disguise her natural muscularity, accentuated by a hyperkinetic nature that her father had channeled into gymnastics when she was a young girl.

  Susan twirled her hand impatiently. “So about this kid…”

  “Nobody’s really sure what’s wrong with him,” Megan explained. “They’re thinking he may have leukemia, but the lymphocytes don’t look typical of leukemia.”

  “What do you mean?” Susan asked.

  “They didn’t find any blasts — there were no leukemic cells in his blood. But who knows how good our lab is down there?” Megan shrugged. “Originally, he wasn’t scheduled to come through the E.R. He was supposed to be stable, a routine admission going straight to the ward, but he started having trouble breathing during the flight up here.”

  The respiratory therapist looked up from connecting her oxygen line to a valve recessed in the wall. “How much trouble?”

  “Enough so that the pilot called ahead to the airport, the airport called us, and we decided to send a transport team to pick him up. The team called in as they were getting ready to leave the airport, said he was on oxygen but still breathing on his own.” Megan glanced at the large, round clock on the wall — it was 7:03 P.M. “That was about twenty minutes ago.”

  Susan scowled. “I’d like to know what genius decided this kid was healthy enough to fly up here.” She turned to Megan. “By the way, are you it tonight?”

  Megan hesitated a beat, irked by where Susan had placed the inflection in her question. “Yeah, just me. I’m the only senior resident on duty.”

  Her voice cracked on the last word, rising a few octaves.

  Damn. Her voice had always had a husky, two-pack-a-day quality. What bothered her more, though, was its tendency to crack when she was nervous or upset.

  Susan squinted at a sheet of paper taped to the far wall. “Who’s the trauma Attending tonight? If we have a kid coming in that we know next to nothing about, I want an Attending here.”

  Megan didn’t have to look at the schedule. She knew that McKenna was the Attending — the supervising physician. He did the scheduling for the E.R., and she was sure it was no coincidence that, whenever she had trauma duty, he was the Attending covering the unit. The message seemed clear: He didn’t think she could handle the challenge of trauma care.

  “It’s McKenna,” Megan said finally.

  “McKenna,” Susan echoed, as if trying the thought on for size. “Good.”

  “Ahh, the Iceman cometh,” the therapist clucked.

  Iceman. The stories abounded, and most centered on Luke’s ability to think clearly and act decisively under extreme conditions that caused even his testosterone-endowed peers to wilt. McKenna did this, McKenna did that, McKenna wrestled a giant gorilla while doing a heart transplant…blah, blah, blah. It was one of those silly macho things.

  She thought the nickname more strange than praiseworthy and sensed that Luke didn’t much care for it either, but then how would anyone know for sure? During the entire eight months of their now-broken relationship, he had rarely shared any feelings deeper than a rain puddle.

  “That’s three times this week — you and him on trauma duty,” the therapist added. “Maybe a tiny flame still burns for the Iceman.”

  The nurses’ heads jerked toward the therapist, then at Megan. An instant later they buried their faces in busy work.

  Megan opened her mouth to respond, but just as quickly gave it up. Nothing she could say would dissuade them from imagining whatever they wanted.

  But, God, I am sooo over him.

  Looking back, it had been a foolish idea from the beginning. He was an Attending, she a lowly resident. Then there was the seven-year difference in their age, though Luke’s military career before medical school left a narrower gap in their professional lives. He had been an E.R. Attending for just three years.

  And as it turned out, none of that mattered.

  What did matter was that Luke had never given himself to their relationship as she had. He seemed unwilling to return the trust and emotional intimacy that she had offered to him so freely. The man was a jigsaw puzzle of conflicting images: decent, kind, but also distant and difficult to penetrate.

  Three months earlier, while struggling through a difficult time, she had finally surrendered her hopes. But because her female counterparts at the hospital were so…so…enamored with him, from time to time they’d remind her of the relationship that she wanted only to forget.

  Another siren. Megan glanced at Susan, who was attaching strips of tape to the edge of the treatment table where she could easily grab them when needed. The nurse didn’t look up from her work.

  The siren abruptly stopped sounding, turned off because the ambulance had reached its destination.

  A woman’s voice squawked through the loudspeaker above the door. “Ambulance in the bay, ambulance in the bay.”

  Megan took in the room and winced as an uneasy feeling visited again. Where is Luke?

  A minute later she heard the gurney’s clanging wheels, then muffled voices. Her stomach tightened.

  Whoosh. The heavy metal doors opened and a small platoon of blue jumpsuits — each sporting a rainbow insignia and the letters UCH — trotted into the room with their stretcher and its diminutive cargo.

  Blankets covered all but the patient’s head. The transport team’s gear was strewn along the edge of the gurney: beige monitors spewing green squiggly lines, bright orange fishing tackle boxes stuffed with drug vials, and a pair of oxygen tanks lying on their sides.

  All that Megan could make out was the boy’s brown hair, the oxygen mask covering his face, and two dark eyes darting around the room.

  Transport personnel were just beginning to disconnect their equipment when the trauma team went to work. Everyone was jockeying for position. A tangle of arms crisscrossed the table as instruments, tape, syringes, IV bags, tubing, and cords passed back and forth at a furious pace. Their work slowed for just an instant when they lifted the boy onto the treatment table.

  That was when Megan got her first glimpse of the boy. His features were Indian — a round face with high cheekbones and straight black hair — and his limbs were emaciated. Whatever his illness was, it had been ravaging his body for many months
.

  Susan called out, “Orders, Doctor?” even before Megan could get close enough to examine the patient.

  Megan squeezed in closer to the table and reached over someone’s stooped shoulder to place her stethoscope on the boy’s chest.

  Behind her, the transport physician had already started into a highly regimented account of his team’s assessment and therapy. It yielded no clues that pointed to a diagnosis and revealed only what they had not found — the boy had no fever, and no abnormal breath sounds.

  “A few minutes after I called you from the airport,” the transport doctor continued, “the patient’s O-2 sat dropped to eighty percent. We increased his oxygen — it’s now running at ten liters a minute — and gave him nebulized Albuterol to open up his airways. But his sat’s are still hovering around eighty-five percent.”

  The boy’s oxygen saturation — O-2 sat — merely quantified what she already knew by looking at him. He was oxygen starved. The question was why? Pneumonia was an obvious possibility, but she’d have expected to hear wheezes or crackles in his lungs, and she didn’t.

  Megan’s head turned to the transport physician. “You start antibiotics?”

  “I wanted to, but our IV came out and we couldn’t get a new line into him.”

  Susan interrupted them. “Doctor, orders?” This time the request sounded more like a command.

  Megan saw the nurses connect with a glance.

  It didn’t help that everyone in this room had more experience than she did, and would instantly jump in and take over if they sensed the slightest hesitation on her part. Working to keep her voice even, Megan called out a long list of blood tests and ordered “shotgun” antibiotics to cover a broad spectrum of possible infections. She glanced back at the transport physician, who shrugged his indifferent agreement.

  “And call radiology, stat,” Megan added. “They were supposed to be here when the patient arrived.”